According to a study conducted at Emory University, the prophylactic use of antidepressants is successful in preventing depression, anxiety, and physical distress in cancer patients. The study, published in the New England Journal of Medicine (344:961-966, 2001), found that providing the antidepressant paroxetine(Drug information on paroxetine) (Paxil) 2 weeks before beginning cancer treatment significantly reduced the development of clinical depression. In addition, the number of patients who had to discontinue cancer treatment because of severe emotional or physical distress was also reduced.
Andrew Miller, MD, professor, department of psychiatry and behavioral sciences at Emory University School of Medicine, and his colleagues at the Winship Cancer Institute and Rollins School of Public Health studied 40 patients with malignant melanoma. Their objective was to prevent depression by treating patients who were about to be given interferon-alpha, an agent predominantly used to treat malignant disorders and infectious diseases. Although an effective therapy, interferon-alpha has been associated with high rates of central nervous system side effects, including the development of severe depression that in some instances has led to suicide.
Significant Prophylactic Effect
Patients were randomly assigned a placebo or paroxetine. Almost 50% of patients who received the placebo became significantly depressed while receiving cancer treatment vs only about 10% in the paroxetine group.
"Patients who received the antidepressant also experienced significantly less anxiety, fewer concentration and memory problems, and far less intense physical symptoms such as abdominal discomfort, pain, and fatigue," said Dr. Miller. "We wonder whether such an approach may have broader applications, including prevention of physical and emotional complications of other cancer treatments and, possibly, even major surgery."
These data provide the first demonstration of the prophylactic use of antidepressants in medically ill patients at high risk for neuropsychiatric disorders.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
